Intravoxel Incoherent Motion Diffusion-Weighted Imaging of Primary Rectal Carcinoma: Correlation with Histopathology

BACKGROUND Comprehensive and precise assessment of rectal carcinoma is crucial before surgery to plan an individual treatment strategy. New functional techniques, such as intravoxel incoherent motion (IVIM), have emerged and could lead to more detailed information. The aim of this study was to evaluate the difference between the rectal tumor parenchyma and normal wall by IVIM and to explore the correlations of IVIM parameters and histopathology. MATERIAL AND METHODS We prospectively enrolled 128 patients with pathologically proven rectal non-mucinous carcinoma with differentiation degree and 16 patients with mucinous carcinoma. All patients underwent routine MR examination and IVIM sequence. The IVIM maps were automatically generated and 3 ROIs were drawn on the maximal rectal tumor parenchyma and normal rectal wall. The Wilcoxon signed rank test, t test, Mann-Whitney U test, and Spearman's rank correlation test were performed. RESULTS All IVIM parameters demonstrated the difference between rectal tumor parenchyma and normal wall (PD<0.001; PD*=0.014; Pf<0.001). Poorly differentiated carcinoma had a significantly lower f value (Pf=0.049) than well/moderately-differentiated carcinoma. In addition, mucinous carcinoma had a higher D (PD=0.001) and a lower D* value (PD*=0.001) than non-mucinous carcinoma. Correlation analysis between IVIM parameters and histopathology showed that D (|r|=0.538, PD=0.000) and D* (|r|=0.267, PD*=0.001) had statistically significant correlations with histological type and f (|r|=0.175, Pf=0.048) was significantly correlated with differentiation degree. CONCLUSIONS The IVIM parameters of rectal tumor parenchyma and normal wall were significantly different. D appears to be a valid and promising parameter to indicate histological features of rectal carcinoma.